This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Monday, 4 February 2008

Stupid Bitch Matrons

Bring Back Matron you say? Oh they are back all right.

At my hospital we always had a saying..."Matrons are like ghosts...we know they exist but we never see them."

Who are the modern matrons? They are highly trained and highly educated nurses who take on clinical specialist/ management roles. Highly trained and highly educated nurses are great at the bedside. Research has shown that patients have a higher survival rate when they are receiving total care by a degree educated RN. Even better if she has a manageable number of patients.

Many of our modern Matrons, however, are as useless as tits on a bull. They have no soul. They have no interest in patients. I would rather eat c-diff positive shit than bestow the honourable title of "Nurse" onto one of these people*.

I have posted the stats regarding Nurse patient ratios. I have posted research into medical errors. I have posted about some of the insane practices that were happening on my ward and continue to occur almost daily. It doesn't take a rocket scientist to figure out that people do and can get hurt. At the very least is the little 90 year old man sat staring at a tray off food he cannot feed to himself..whilst his nurse is busy elsewhere. If anything makes me feel like going postal, it is that scenario. Staff nurses are not perfect and they do make mistakes, but many of the mistakes that happen are down to system errors that could have been prevented.

My ward was opened to another specialty and now takes 3 or 4 different specialties. We are the (now 40 bed) dumping ground for EVERYTHING. This was the result of a management decision that was not thought through. As usual we are left worse off than we were prior to said management decision. None of the RN's were cross trained and fuck up after fuck up occurs daily. The nurses are stuck with too many patients, no back up, no support in a specialty in which they have little or no experience.

The Matrons know the situation. There are many many highly paid matrons at my hospital. One for each specialty. Did any of them come to the ward to provide guidance and leadership or help out during the restructuring? HELL NO. They basically disappeared into thin air. Totally fucking AWOL.

Did they put on a pinny and come and help out on the ward? HELL NO.

Did any of them come anywhere near the ward or a patient? HELL NO.

Did they return our phone calls? Rarely.

Have we ever seen them act like a nurse? HELL NO.

Would any of them be able to name a patient on our ward? Nope.

Once, two years ago, a Matron did come to the ward to help us put because we were so short. This is the only time we recollect that this has happened. I was overwhelmed with really sick patients. Matron informs me that A. She does not remember how to do a drug round and will not do it. B. She is not comfortable with IV meds and will not help with that. C. She volunteered herself to answer the phone and call lights. So I got left with all the hard stuff, and supersuck (who makes double my salary) did fuck all.

That was the last time we saw a Matron (or a Nursing Leader) on the ward in a clinical capacity. They stay far far away and leave the staff nurses to suffer alone. We have written letter after letter about the conditions on these general wards and they are ignored, or Matron shrugs her shoulders and says "we feel so bad for you".

What.The.Fuck?

Don't feel bad for us...you are a highly paid nurse...get your arse to the floor and help us...be a goddamn nurse...provide some goddamn leadership by example. Come up with a plan for cross training the staff. Back us up when we are getting threatened by the chief nurse for complaining when we are one nurse to 24 patients. At the very least come and help us feed patients when YOU KNOW that we are 2 nurses to 15 feeds and everything else that is happening simultaneously. I have worked with bedside nurses who have masters degrees and chose to work at the bedside. The situation is so bad, it should be all hands on deck. Fuck whatever it is that you do all day. I have yet to see anything that you "do" benefit a patient.

I don't know what they do in that office all day. I don't know why they hate their nurses. I don't know why whatever the fuck they are up to in that office is so much more important than the patients and the staff.

I do know that despite the fact that they know how short we are working, they love to re-arrange our paperwork and make it more complex. Certain forms have gone from 5 pages to 20. I know that they are trying to redesign our care plans because the current ones are never filled in properly. I informed the Matron that it doesn't matter what structure our paper work takes...it is going to be FUCKED because of time constraints and overwhelming nurse patient ratios. I must not have got through.

When do we see Matrons? When there is an inevitable cock up. Then they are down to the ward like flies to a horses ass to ensure that all blame is directed onto the staff nurse and the hospital does not appear negligant or liable. Then the same error happens again with a different nurse because these are SYSTEM errors not NURSE errors. Once again Matron comes down hard on the individual member of staff without troubleshooting the problem. Fucking worthless whores. I saw it happen to too many of my colleagues and I got the hell out before the day came when it was my turn.

As far as I am concerned, most of our so called nursing leadership are traitors to nurses and patients alike. Don't even get me started on the NMC, the RCN or any of the other worthless pieces of crap who refuse to address the real issues. I'd like to see them all lined up and shot*.

*if there are any Matrons out there reading this that care about patients and support their nurses than I apologise to you personally. The rest of you are overpaid stupid worthless bitches.

*Nurse Anne is a non-violent pacifist and she does not believe in shooting our so called nurse leadership for their crimes. She just fantasizes about it.

Can you sort of anonymously take this stuff to the papers? I mean, I know you're writing this blog and I read it, but that's because I'm a nurse too.

I'd just love the public to have an idea about this other than the crapola of "Too posh to wash, too clever to care" Funny how nurses only became like that when Hewitt and people of that ilk came to power.

Dear Nurse AnneI understand and feel your pain - I am a British nurse working in USA and its not much better here. The equivalent of the Matrons here ponce about in suits, silk scarves and high heels. When I tried to get some support and improve staffing and morale on my ward (and the in the hospital in general) I was seen as a threat and was later written up for moving a cupboard 6 feet across a hall. As a Unit Director I worked alongside my nurses and often took the role of Charge Nurse so they could have an extra nurse on the floor. I always came in if they were short staffed as well. However I was treated like dirt so left. I am appalled by the nonsense that goes on - you are right, they just stay far away and have another coffee break. Why not ask your hospital to do a staff satisfaction survey. I now work from home for an insurance company with no stress or issues - so that hospital lost an experienced unit director RN with masters degree and tons of experience - and guess what they dont give a shit.

The might be so called modern matrons but they are still wolves in sheeps clothing as far as I am concerned. A so called modern matron is the only person who has managed to make me cry on more than one occasion. I don't cry easily either..xx

Amen to this post. I have lost count of the times when the superb nurses I work with have been run ragged, while some pillock in a power suit carrying a clipboard swans around doing nothing (and earning much more). I'm not trying to pimp my blog here (honest!), but I blogged a piece called "The rage" on our site about this exact thing a few months ago. Doesn't matter how good a nurse you are, if you're overwhelmed with patient numbers you're gonna make fuckups.

I don't think you swear enough given the dire situations you are describing and the current shite managers who see only targets, figures and lovely, lovely admin.It really is 'The Emperor's New Clothes' because matrons, managers, and so on up to the government really do believe in the fantastical world they have created.There's a problem with infections: create more protocols and committee meetings.Employ another managerial suit to head it up.There's a problem with transferring patients within the target times: review the existing policies and procedures and have yet more meetings. Employ another managerial suit to head this one up. There's a problem with.......Ad infuckingfinitum.One band 8A = two band 5 nurses.Maybe one way to approach the modern matron is to look closely at their job description because I am sure part of their role is to educate, disseminate and support staff. How can they justify their registration without hands on patient contact?Sorry but my comment is becoming a novel so I'll stop now.Excellent blog by the way and now saved to my favourites.

We have a Modern Matron, (He is the very model of a modern nusing matron), apart from acting as the unit managers gofer and filling in PDF's (personal development plans) according to the KSF (knowlwedge skills framework) for the PBI (poor bloody infantry) I have no idea what he does. Nor do I care.

Another lay person here. How I feel for you. Anyone who works in any organisation knows the type. They know all the latest buzz-words and jargon to throw around in their interminable meetings. The higher the jargon & bullshit level, the more ineffective they are at doing their job. The way of the world, unfortunately.

Hi just stumbled on your blog.. I worked as an HCA for 2 years before I got my place at med school, and my God it takes me back! You've captured everything I hated over the time I was there. As far as I could tell, our matron only ever shafted our (fantastic) Ward Sister and got her the sack before installing her (equally useless) friend in the post. I can't even begin to tell you the catalogue of horror stories I encountered over that time! Thanks for bringing this to the attention of the public so superbly! Keep it up...

Nurse Anne, your blog has made a difference - to me! I was one of those relatives who nagged on at the nurses about lack of care for my parents when they were in hospital. Having read your side of the story I'm going to show nurses respect & encouragement from now on.

Am I going to stop complaining - HELL NO! My dad's 92 and gets scared when he's left on a commode behind the curtains for ages and hates it when his legs ulcers aren't dressed and they stink.

My mum (87) is heartbroken when she has to wet the bed when no commode is forthcoming after asking for ages. She waits in pain for some relief and a bit of reassurance about worrying symptoms.

Yeah! I used to think nurses were heartless & get mad - I love my mum & dad, I'm their carer & I care - and I'm a pensioner myself and running out of steam and patience!

But - I now apologise to all the nurses I've pressured & complained to in the past. From now on I shall request an audience with the duty manager and enquire how they justify staffing levels so low that nurses are unable to do their work as they & their patients would wish.

This is one of the many reasons why I have left nursing after 15years and became an ER Tech.Money versus stress.I still have my license,but do not see returning to nursing anytime soon.I am checking in to organ harvesting or becoming an embalmer.Texas needs nursing unions.I have met many nurses who have left for other work in the last year.

Patient Flow ManagerPerson who wanders around with clipboard and places brightly coloured magnets around the ward bed board. Asks about numbers of patients and oftens hands outs patients like sweeties.

Bed ManagerPerson who wanders around with clipboard and moves the aformentioned magnets around some more. Asks about numbers of patients and beds.

Staffing ManagerPerson with clipboard who wanders around with clipboard and moves the aformentioned magnets around some more. Asks about staffing and can they takes some away without regard to numbers of patients in ward.

Hospital CoordinatorPerson who wanders around with clipboard and moves the magnets around even more. Asks about staffing and takes some away.

Discharge CoordinatorPerson who wanders around with clipboard. Is only interested in green magnets. Sometimes takes patients away. She is my friend

Throughput ManagerPerson who wanders around with clipboard. Is only interested in orange and red magnets.

Clinical Nurse ManagerPerson who wanders around with clipboard and notepad. Not interested in magnets or staffing or beds.

They dont talk to each other. They do like magnets though.

I kid you not. Seven managers, all senior nurses, seven days a week. Not one adds anything to my day.

I have been in my A&E department for 6 years...during that time we have had 2 matrons.

I have NEVER seen either of them liase with ANY patient in ANY way. They both have been INVISIBLE and UNAPPROACHABLE to staff and patients...presumably off attending meetings maybe...about targets...or finance ..or... foundation status.. I don't bloody know!

Both matrons had habit of...(like Nurse Anne says)... only coming into the department to rearrage cupboards or paperwork without telling us / complain about staff being too happy(god knows how that happens)/ point out dust / bollock staff in the event of issues or errors (but never praise when we work miracles)...oh...and most important of all..to deal with any INCONVENIENT PATIENTS who are nearing 3 hours 50 minutes! (only they dont 'deal with the patient'..they hound and hammer the harrassed nurses to drop WHATEVER you are doing NOW and sort it...as if we can't ALREADY tell the time..or count to 4...or SAFELY prioritise our own workload).

When patients numbers exceed hospital beds..the matrons pally up with the managers ('gaggle with clipboards') and effectively become a manager. In my view (or in my hospital should I say).. matrons are an extension of management...and certainly not any part of the nursing team.

When you hear medics bitching about nurses with clipboards these are the people they mean. The two percent that give the entire profession a bad name.

There's no reason nurses shouldn't go to university, but when kids are recruited out of school they're invariably talked to by the same bunch of powersuited clowns and persuaded that nursing is an academic degree equal to a BA, a good "first degree", an excellent starting point for all manner of different careers. They're told about being clinical service directorate managers and making 60k+ per year. No one actually asks if they're interested in nursing - caring - for sick people. So off to university they go (as does everyone else in the UK now), the government spends vast amounts of money on bursaries and free tuition fees and book grants and whatever else to attract more people into nursing. Sadly it turns out a lot of them hit second or third year and don't really want to be "normal" nurses, only to find that their "academic" qualification isn't as highly regarded in the workplace as they were lead to believe.

Changing the way we think of nurses in society is important, but isn't about promoting them all to managers or independent clinicians or specialists or brain surgeons. It's about valuing the central, difficult, demanding, highly skilled role they've always played in caring for patients

When I started my nursing degree we were told that a degree is better than a diploma because it gives you more "options" later on.

Our nursing instructors told us that no one lasts more than 5 years as a ward nurse. Your spirit gets broken, the constant abuse and stress destroys your mental health. Physically speaking, ward nursing is not a sustainable occupation long term.

Yes, we were told to get degrees right away so that when our backs,knees, and hips are ruined before the age of 30 we will at least have job options away from the ward.

Does the ward environment need to be so bad in the first place? I don't think so.

Hi, I'm a student, in my last year, and am predicted to get a 1st in my BSc(Hons). I love nursing and am good at it. However, I am NEVER EVER going to nurse. I am 44yrs old, and boy I just can't cope with the shit! I think it is much better to stay in the comfort and safety of the academic ivory towers and chat about policy, sorry. But I am praying for you guys.

As a taxpayer I have a bit of a problem with that attitude. You're getting your fees paid for, you're getting a bursary on top of that. Maybe it's a vicious cycle, but surely part of the problem of stretched resources is down to the incredibly high attrition rate?

As for the 1st class BSc (hons), I'm sure your very bright and work very hard and I'm not saying nursing school isn't as difficult or challenging as a degree in other, more traditionally academic, subjects, but come on - for three years part time university study of basic human biology?! I know i'll get shot for this, but surely that to some extent devalues the degrees your university confers on science undergraduates who've done nothing but physics/chemistry/architecture/anatomy/etc full time for three years?

After three years in medical school with 1st class marks in (supposedly degree level) anatomy, biochemistry, physiology, pharmacology, microbiology, and pathology if I'd decided to leave I would have had a third class normal degree.

OMG! Just found your blog from Grand Rounds. You are hilarious. Love it. "Matron" or whatever the hell you call them should be required to staff a percentage of the time. Especially the nurse educators. They really need to walk the walk if they are going to talk the talk. Otherwise not one will, or should, take them seriously. Your post is a case in point.

I am a wound specialist (Matron). Had a long hard day single-handedly covering wound/ skin consults at two different hospitals each >300 beds each. Last one seen was due to an order that staff nurse asked MD to write due to a very mild heat rash at the back side. You have got to be kidding me!!!! You are sucha pain in MY backside!!! Yes, I am well paid----salaried which means when I stay late trying to see all of the cockamamy stupid consults, I am actually very mad and underpaid by the time I drag home at night.Sooooo, I cam home sat down to my laptop and typed in "nurses are stupid and lazy" in web browser and low and behold this "Stupid Bitch Matron" popped up. I read the whole thing, totally seeing the other side and I laughed so hard, I cried. I guess it's all perspective. I have always said staff nurses have the heardest jobs in the hospital, EXCEPT for the stupid lazy ones with their feet up on the desk, texting their sig. other and just don't care how well they do their job. But you gave me the perspective that they are probably saying the same about me. I do happen to be one of the "matrons" who take time to feed those patients with a tray in front of them that they can't eat whilst the whole time silently cursing the staff member that should be doing this. Guess it boils down to theres good people and bad, hard working and lazy, those that go the extra mile and minimalists, those that blog about how mad they are and those that sleep like a baby! But really, thank you for making me laugh and let it go...need to sleep.

It's the patients who want every silly little rash seen to my dear, not the nurses.

"I do happen to be one of the "matrons" who take time to feed those patients with a tray in front of them that they can't eat whilst the whole time silently cursing the staff member that should be doing this"

The whole problem here is that this individual staff member has 20 other patients to feed and drugs due in that 20 minute window as well. It's not like he/she just has one or two patients to feed. What would be really nice would be if we had someone to answer the phone that rings non stop over mealtime.

But the matrons shot us down on that, and they also bust our asses when callers complain that the phone is not getting answered. So I guess we will just have to continue running to the phone ten times a minute during meal time.

Seriously, what kind of retard hospital does not have ward clerk back up for their nurses until 10 PM at night?

Matron I just wanted to add that it is normal for staff nurses on my ward to HAVE to stay over at least 1 or 2 hours at the end of our shifts UNPAID because of the short staffing and poor working conditions. 1 or 2 hours is a pretty conservative estimate. And that is after not taking a lunch break.

I have had not so many experiences with nurses, ones were good experiences, but others not very much. Anyway, I guess we have to thank them because of their huge effort to help us when we need it the most.

shot me now i'm a community matron!but only when things go wrong, rest of the time I'm a team leader.For the last 8 years i have been leading a large team of community nurses and unlike you lucky hospital nurses our 'wards' do not have a set number of beds we just keep taking more and more patients and prey for flu epidemics and such like to clear the caseload a little.I have been reprimanded by my management for seeing patients that could be seen by lower grade staff(ie any grade less than a band 7). I have totally ignored my management and have got on and done the work when we are short staffed because my patients come first and they do'nt give a toss who helps them as long as someone does. I rarely tell patients my grade, or that I am the team leader as I think it's irrellevant. Most are shocked so I hear later from subsequent staff that visit that the manager came and provided care. But after 8 years of covering chronic staff shortages, doing double shifts and numerouse unpaid hours of work both at work and at home i am now off sick myself with stress. And I feel guilty about leaving my remaining staff even more short staffed.So this is the price I have paid for trying to do everyones job,Bear in mind that I can do a band 2 or 5 work but the but they cannot do a great deal of mine. So Do'nt knock all the matrons most of us are truly the meat in the sandwich between management and frontline staff.Maybe we end up going one of two ways, avoid patients and staff so you can take a detached quantative view, or work with patients and staff be truly concerned about quality and the things patients want and end up stressed out and unable to work at all. If I end up leaving the profession that will be one less thorn in my managers side.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.